In the UK, current policies and services for people with mental disorders, including those with intellectual disabilities (ID), presume that these men and women can, do, and should, make decisions for themselves. The new Mental Capacity Act (England and Wales) 2005 (MCA) sets this presumption into statute, and codifies how decisions relating to health and welfare should be made for those adults judged unable to make one or more such decisions autonomously. The MCA uses a procedural checklist to guide this (...) process of substitute decision-making. The personal experiences of providing direct support to seven men and women with ID living in residential care, however, showed that substitute decision-making took two forms, depending on the type of decision to be made. The first process, ‘strategic substitute decision-making’, paralleled the MCA’s legal and ethical framework, whilst the second process, ‘relational substitute decision-making’, was markedly different from these statutory procedures. In this setting, ‘relational substitute decision-making’ underpinned everyday personal and social interventions connected with residents’ daily living, and was situated within a framework of interpersonal and interdependent care relationships. The implications of these findings for residential services and the implementation of the MCA are discussed. (shrink)

This paper presents a theory of algorithms designed to optimize highly interactive systems (multi-diminsional, multi-peak, nonlinear functions). Two applications are discussed: one concerns cognitive systems capable of learning and generalization, and one concerns calculations dealing with the "origin of life" from "organic soups". The algorithms are intrinsically parallel--each function argument processed serves as a carrier for information about a tremendous number of regions (hyperplanes) in the function's domain. Each region is automatically ranked according to the estimated average value of the (...) function over that region, and the rankings are compactly stored in the algorithm's data base (M l-tuples store approximately M-2 l/2 rankings). Thus, the algorithm implicitly processes hyperplanes by manipulating function arguments. (shrink)

The lexicographic power ΔΓ of chains Δ and Γ is, roughly, the Cartesian power Πγ∈Γ Δ, totally ordered lexicographically from the left. Here the focus is on certain powers in which either Δ = R or Γ = R, with emphasis on when two such powers are isomorphic and on when ΔΓ is 2-homogeneous. The main results are: (1) For a countably infinite ordinal α, Rα* +α ≃ Rα. (2) RR ≄ RQ. (3) For Δ a countable ordinal ≥ 2. (...) ΔR, with its smallest element deleted, is 2-homogeneous. (shrink)

In this Very Short Introduction, John H. Holland, one of the leading figures in the field, introduces the key elements and conceptual framework of complexity. From complex physical systems such as fluid flow and the difficulties of predicting weather, to complex adaptive systems such as the diverse and interdependent ecosystems of rainforests, he uses simple examples to illustrate the approach and insights provided by complexity theory.

I argue that while there is no evidence that Roy Holland was influenced by Henri Bergson, their views of morality nevertheless reveal an interesting similarity.

In lieu of an abstract, here is a brief excerpt of the content:The Tincture of the Doctor's TimeHolland KaplanI first thought of Mr. H as a "difficult patient" while reading the written hand-off I received on him as I was preparing to take over an inpatient general medicine service—"He leaves all the time to smoke." I don't think the statement was meant to imply anything about the patient; if anything, it may have been included for context to prepare me for (...) the patient's intermittent absence. But, reading this, I felt a familiar sense of annoyance rising in my chest. Every few months, I take care of a patient who seems to never be in his room. The patient is consistently out smoking, in the cafeteria, or in another unknown location, seemingly doing an undisclosed activity. This is frustrating because it means I have to work around the patient's schedule of smoke breaks and jaunts to the cafeteria to evaluate the patient on a daily basis. The thoughts inevitably cross my mind: Does this patient even want care in the hospital if he's never in his room? Is he actually sick enough to need to be in the hospital if he's able to spend so much time outside of the hospital? Why is he leaving so frequently—is he doing drugs?This particular patient had been in perfect health until two months before I met him when he was shot multiple times during an encounter at a gas station. One of the bullets had lodged in his back, shattering a vertebra. Another had decimated the bones in his right upper arm, which were now held in place by screws and plates. Several had landed in his abdomen, necessitating the removal of part of his bowel. Finally, a bullet had sliced through the lower part of his right kidney, shredding his ureter and mandating surgical reconstruction of his urinary system. After over a month in the intensive care unit with multiple reparative surgeries, he was discharged to a rehabilitation facility. But he started having fevers and fast heart rates; ultimately, he was admitted to the hospital again for multiple infected fluid collections that had formed at the sites of his surgeries. He left the hospital prior to getting treated for these infections, purportedly "against medical [End Page 12] advice." And now, several weeks later, he was here in the hospital for the same reason.The first time I went to see Mr. H, he was, of course, not in his room. I went to the nursing station to ask if the clerk knew where he was. She knowingly said, "Oh yeah, he goes out a lot. I can give him a call to let him know the doctor is here to see him if you'd like." I assented, thanked the clerk for calling him, and proceeded, annoyed, in seeing the rest of my patients. I considered how I would address Mr. H's behavior when I was finally able to talk to him. I had seen others take many different approaches—negotiation about the timing and frequency of these extramural expeditions, ultimatums about getting discharged, mandating urine drug screens upon return, and silent, frustrated tolerance. I resolved to wait to speak to him to determine which approach might be most suitable. An hour later, I received a call from the clerk that Mr. H had returned to his room to see me.The first time I met Mr. H, he informed me he had taken the bus to midtown to make a run to the grocery store. I was internally incredulous. He felt well enough to go to the grocery store? Why was he in the hospital then? At that moment, I opted not to discuss his frequent departures yet, as I was frustrated and realized I wouldn't be able to identify the best way to address them. I reviewed his medical issues with him, asked specific questions about how he was feeling, performed a physical exam, and reiterated his current plan of care. Mr. H made it very clear that he would like to get out of the hospital as soon as possible. I tried to set the expectation that he... (shrink)

I propose this: Ellen [a graduate student] laughs because she is re-creating her identity. This theory differs from the others because "identity" is not simply a category that is filled or not, like "incongruity" or "superiority" which become variables in an "if this, then that" explanation. "If there is a sudden incongruity, people will laugh." Rather, identity is a further question, a way of asking, Can I understand Ellen's actions as a theme and variations? Moreover, any such interpretation is itself (...) a part of the interpreter's actions, hence a function of his - in this case, my - identity. The principle is general, but putting it into practice in each instance is unique. Unlike an "if this, then that" which leads to closure, an explanation through identity leads to a continuing dialogue. One asks questions of an individual situation, like Ellen's laughing at [B.] Kliban's cartoons. One gets answers that lead to a fuller understanding of that situation. The answers can be generalized into questions, leading to more and closer questioning and more answers that lead to more questions, all within the general principle of identity re-creation as embodied in the unique situation.Norman N. Holland is the James H. McNulty Professor of English at the State University of New York at Buffalo. He has written a book on the theory of laughter presented in the present essay. His previous contributions to Critical Inquiry are "Literary Interpretation and Three Phases of Psychoanalysis" and "Human Identity". (shrink)

In the Netherlands the government's proposal for the legal regulation of euthanasia, assisted suicide and the termination of a patient's life without request has been approved by Parliament. The defence of this proposal is to a large extent based on a specific interpretation of data about the practice of euthanasia in that country, published in 1991 (the Remmelink Report). This paper discusses both the interpretation of the data and the new law. On the basis of that and other data, the (...) author concludes that many cases of euthanasia, assisted suicide and termination of a patient's life without request remain unnotified and therefore unreviewed by the legal authorities. It is argued that the new law will not guarantee an improvement to this situation. In short, the new law will not protect effectively the lives of patients, and must, therefore, be open to ethical and legal objection. (shrink)

This is certainly true for every translation, because every translation must necessarily accomplish the transition of the spirit of one language into that of another.We all know who and what Creon was. He was a tyrant—a proto-Nazi, according to French playwright Jean Anouilh. He was not even the same person in Sophocles's three Theban plays, according to translator H. D. F. Kitto.2 He was Antigone's uncle, her mother's brother. He was a symbol of the transition from a "rule of tradition" (...) to a "rule of law" in ancient Greece, according to political scientist Catherine A. Holland.3 We also all know what those terms mean—tyrant, the same person, uncle, brother, rule of tradition, rule of law.... (shrink)

Turbulent and fast moving markets demand flexible organizations capable of accurate and effective handling of knowledge and information. This article describes some essential parts of this knowledge and information management in Hendrix Voeders Holland, a Dutch feed factory. It concentrates on the Support System, an information technology (IT) application that allows the agricultural advisors to store and retrieve market information in a structured and uniform way, facilitates the information exchange with “headquarters” (e.g., gives the managers access to this information), and (...) makes immediate feedback and action possible. This system was rewarded with the IT Star Award in a worldwide competition of BP Companies. Special attention is given to a part of the Support System: the Daily Reports. In 1989 it was evaluated thoroughly, and the results of this survey are summarized. (shrink)